Improving extent of glioblastoma resection by combining volumetric MRSI and 5-ALA

结合体积 MRSI 和 5-ALA 提高胶质母细胞瘤切除范围

• 批准号: 8699970
• 负责人: Constantinos George Hadjipanayis
• 金额: $ 33.69万
• 依托单位: EMORY UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-04-01 至 2016-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8699970
• 关键词: Aminolevulinic Acid; Brain; Choline; Clinical; Computer software; Consensus; Control Groups; Data; Data Display; Detection; Edema; European; Excision; Fluorescence; Glioblastoma; Gliosis; Image; Imaging Techniques; Imaging technology; Infiltration; Lead; Lesion; Magnetic Resonance Imaging; Malignant Glioma; Maps; Metabolism; Microsurgery; Modality; Nature; Neoplasm Metastasis; Neuraxis; Neuronavigation; Neurosurgeon; Newly Diagnosed; Operative Surgical Procedures; Oral Administration; Outcome; Patients; Pattern; Phase; Primary Brain Neoplasms; Process; Radiation therapy; Recurrence; Residual state; Residual volume; Resolution; Signal Transduction; Site; Specimen; System; Technology; Time; Tumor Tissue; Weight; base; brain tissue; chemotherapy; clinical application; clinical practice; computerized data processing; disorder control; image registration; image visualization; improved; magnetic resonance spectroscopic imaging; molecular imaging; neurosurgery; outcome forecast; phase 2 study; public health relevance; spectroscopic imaging; standard of care; temozolomide; tool; tumor

DESCRIPTION (provided by applicant): Glioblastoma (GBM) is the most common primary brain tumor and is almost uniformly fatal. The standard of care for GBM patients is neurosurgical resection, followed by radiation therapy and temozolomide chemotherapy. Traditional neurosurgical resection of GBMs has relied on the use of neuronavigation based on pre-operative contrast-enhanced MRI; however, it is known that nonenhancing, infiltrating tumor extends well beyond the margins of enhancement. GBM tumors rarely metastasize outside the central nervous system (CNS). Most tumors will recur within centimeters of the initial tumor, making local control of disease a high priority. Radical resection of GBM tumors, however, is challenging due to their infiltrative nature within the adjacent normal brain. Current technology relies on microsurgery, neuronavigation based on contrast- enhanced MRI, and the use of intraoperative MRI when available to maximize surgical resection. Given the patterns of tumor infiltration and recurrence, more complete resection of these tumors may improve local control and, ultimately, patient survival. We propose to improve the extent of GBM resection beyond the MRI contrast-enhancing tumor margins in patients by combining magnetic resonance spectroscopic imaging (MRSI) and 5-aminolevulinic acid (5-ALA) fluorescent-guided surgery (FGS). With the use of both of these technologies, GBM patients may undergo more complete resections of their tumor. MRSI provides, which can display the distribution of endogenous metabolites within tumor tissue as a molecular image/map, has shown benefit for the differentiation of tumor and non-tumor lesions. Choline/NAA ratio maps derived from these studies can clearly demonstrate infiltrative, high grade tumor beyond MRI contrast-enhancing regions found on preoperative MRI. On the other hand, 5- ALA FGS provides intraoperative real-time guidance to differentiate tumor from normal surrounding brain tissue. By including MRSI registered with MRI neuronavigation in combination with 5-ALA FGS, neurosurgeons will be able to push the margin of tumor resection outside the boundary of contrast-enhancement in patients with noneloquent tumors. Our proposal will take advantage of recent advances in MRSI technology and the image registration and visualization tools, which will permit clinicians to display, review and interpret MRSI data more easily, thereby making routine clinical application possible. Use of MRSI and FGS may facilitate more safe removal of tumor tissue beyond the enhancing tumor margin, potentially improving overall survival clinical outcomes for patients with GBM.

描述（由申请人提供）：胶质母细胞瘤（GBM）是最常见的原发性脑肿瘤，几乎是致命的。GBM患者的标准治疗是神经外科切除，然后是放疗和替莫唑胺化疗。传统的神经外科切除GBMs依赖于使用基于术前对比增强MRI的神经导航；然而，我们知道，非增强的浸润性肿瘤的范围远远超出了增强的边缘。GBM肿瘤很少转移到中枢神经系统外。大多数肿瘤会在最初肿瘤的几厘米内复发，因此局部控制疾病是重中之重。然而，由于其在邻近正常脑内的浸润性，根治性切除GBM肿瘤具有挑战性。目前的技术依赖于显微外科手术、基于对比增强MRI的神经导航，以及术中MRI的使用，以最大限度地进行手术切除。考虑到肿瘤浸润和复发的模式，更彻底地切除这些肿瘤可能会改善局部控制，并最终改善患者的生存。我们建议将磁共振波谱成像（MRSI）和5-氨基乙酰丙酸（5-ALA）荧光引导手术（FGS）相结合，以提高患者在MRI增强肿瘤边缘以外的GBM切除程度。通过使用这两种技术，GBM患者可以接受更完整的肿瘤切除。MRSI能够以分子图像/图谱的形式显示肿瘤组织内内源性代谢物的分布，对肿瘤和非肿瘤病变的鉴别有一定的帮助。这些研究得出的胆碱/NAA比值图可以清楚地显示浸润性、高级别肿瘤，超出了术前MRI造影增强区域。另一方面，5- ALA FGS提供术中实时指导肿瘤与正常周围脑组织的区分。通过将MRI神经导航与5-ALA FGS相结合的MRSI，神经外科医生将能够在非肿瘤患者的对比增强边界之外推动肿瘤切除的边缘。我们的建议将利用核磁共振成像技术的最新进展以及图像配准和可视化工具，这将使临床医生更容易显示、审查和解释核磁共振成像数据，从而使常规临床应用成为可能。MRSI和FGS的使用可能有助于更安全地切除肿瘤边缘以外的肿瘤组织，潜在地改善GBM患者的总体生存临床结果。